stroke Flashcards
features of ACA stroke?
Contralateral hemiparesis and sensory loss, lower extremity > upper
features of MCA stroke?
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
features of PCA stroke?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
features of weber’s syndrome (branches of PCA that supply midbrain)?
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
features of posterior inferior cerebellar artery (aka lateral medullar + Wallenberg)?
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
features of anterior inferior cerebellar artery (aka lateral pontine) stroke?
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Ipsilateral: facial paralysis and deafness
features of ophthalmic/retinal artery stroke?
Amaurosis fugax
features of basilar artery stroke?
‘Locked-in’ syndrome
features of lacunar stroke?
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule
what are the 2 types of stroke?
ischaemic
haemorrhagic
RF for ishacmeic stroke?
General risk factors for cardiovascular disease
age
hypertension
smoking
hyperlipidaemia
diabetes mellitus
Risk factors for cardioembolism
atrial fibrillation
RF for hemorrhagic stroke?
Risk factors
age
hypertension
arteriovenous malformation
anticoagulation therapy
what are TACI?
involves middle and anterior cerebral arteries
all 3 of the below criteria are present:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
what are PACI stroke?
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the below criteria are present:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
what are lacunar infarcts?
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
what are POCI?
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
features of haemorrhage stroke?
decrease in the level of consciousness
headache
nausea and vomiting
seizures
what are the IX done?
non contrast CT
maybe MRI
who gets thrombolysis for ischameic stroke?
patients present with 4.5 hours of onset of stroke symptoms
the patient has not had a previous intracranial haemorrhage, uncontrolled hypertension, pregnant etc
what is the immediate management for ischameic stroke?
Once haemorrhagic stroke has been excluded patients should be given aspirin 300mg as soon as possible and antiplatelet therapy should be continued.
what is mx of TIA?
give aspirin 300 mg immediately, unless contraindicated e.g. the patient has a bleeding disorder or is taking an anticoagulant (needs immediate admission for imaging to exclude a haemorrhage)
what is mx of hemorrhagic stroke?
Anticoagulants (e.g. warfarin) and antithrombotic medications (e.g. clopidogrel) should be stopped to minimise further bleeding. If a patient is anticoagulated this should be reversed as quickly as possible.
how do stroke appear on CT?
acute ischaemic strokes:
- may show areas of low density in the grey and white matter of the territory. These changes may take time to develop
- other signs include the ‘hyperdense artery’ sign corresponding with the responsible arterial clot - this tends to visible immediately
acute haemorrhagic strokes:
- typically show areas of hyperdense material (blood) surrounded by low density (oedema)
what needs to happen before thrombolysis can be performed?
Blood pressure should be lowered to 185/110 mmHg before thrombolysis.
what is secondary prevention for stroke?
clopidogrel
aspirin is recommended after an ischaemic stroke only if clopidogrel is contraindicated or not tolerated
